Comprehensive, peace-of-mind cover.

As part of the emergency services community, you can appreciate just how fragile life can be, and how important the health of you and your family really is. That’s why Emergency Services Health only specialises in the very best top-level cover for first responders - there shouldn’t be any compromises when it comes to your health.

Hospital 35-day rule
State
FAQ Answer
Hospital benefits are payable 365 days a year. However, if your hospital stay exceeds 35 consecutive days you must obtain and send us an Acute Care Certificate to continue receiving comprehensive benefits. Benefits will be reduced and out of pocket expenses apply where an Acute Care Certificate is not obtained.

The hospital is aware of this and will usually arrange a certificate on your behalf.
Hospital - What isn't covered? 
State
FAQ Answer

What is not covered (non-exhaustive list*)

  • Services incurred before waiting periods have been served.
  • Treatment for which Medicare does not pay a benefit, including cosmetic surgery. (Some benefits may be payable for hospital treatment following this surgery. Please call us for more details.)
  • Services that are provided outside of the Commonwealth of Australia.
  • Services where an entitlement exists or may exist under any compensation, sports club or third party insurance.
  • A claim for a service that is submitted more than two years after the date of service.
  • Outpatient services, unless there is an agreement between Emergency Services Health and the hospital.
  • Pharmaceuticals not related to the reason for hospitalisation or not covered under the agreement with the hospital or provided on discharge.
  • Exceptional high cost drugs where no or limited benefits are paid.
  • Prostheses items that are not included on the Federal Government approved list.
  • Charges greater than the benefit defined in the Federal Government’s Prostheses List.
  • Personal and take-home items, e.g. newspapers, toiletries, television, hairdressing, manicure, etc.
  • Treatment provided to a person in a private hospital emergency department.
  • Aged care and accommodation in an aged care facility.
  • If you’re in hospital for more than 35 consecutive days and not classified as an acute care patient, your benefits will significantly reduce.
  • Benefits for ambulance services covered by a third party arrangement such as a State/Territory transportation scheme.

* This provides a general description of what is not covered. These are not “excluded or restricted” hospital treatments or services. Should you require information about a particular treatment or benefit please call us on 1300 703 703.

Hospital - What's covered? 
State
FAQ Answer
These days many policies are paring back cover, not paying benefits for certain treatments (exclusions) or paying only limited benefits (restrictions). Not at Emergency Services Health. Our Gold Hospital cover is comprehensive and covers all treatments and procedures where Medicare pays a benefit.
 
Recognised health providers
State
FAQ Answer
Recognised health providers are those who are in private practice in Australia and recognised by us. We only pay benefits for services by these providers. If you wish to ensure that your provider is covered please refer to our online provider search (for a non-exhaustive list) or speak to us prior to treatment.
 
Waiting periods
State
FAQ Answer

Like all private health funds, Emergency Services Health has waiting periods for new members, including people transferring from another insurer when taking out a higher level of cover. Waiting periods also apply to current members upgrading their cover.

Waiting periods are designed to protect the interest of our members. Without them, it would be easy for people to join only at the times when they need cover and to receive benefits. This would lead to higher premiums for all fund members.

At Emergency Services Health the waiting periods are:

Hospital benefits of Gold Hospital and Gold Combined:

  • 2 months membership for all benefits, excluding accidents
  • 12 months membership for obstetric treatment
  • 12 months membership for pre-existing conditions, excluding psychiatric care, rehabilitation or palliative care.
  • 12 months membership for continuous positive air pressure (CPAP) machines, and goods and services under Non-surgically Implanted Prosthesis and Appliances and other aids and appliances.

Extras benefits for Rolling Extras and Gold Combined:

  • 2 months membership for all benefits, excluding accidents
  • 12 months membership for major dental (like crowns and dentures) and orthodontics, hearing aids, nebulisers, blood glucose & blood pressure monitors, blood coagulation monitor and for pre-existing conditions
  • 12 month membership for Rollover Benefit (2 years Major Dental).

Gold Combined:

  • 3 years membership for corrective laser eye surgery.

It is important to note that if you are transferring from another insurer, waiting periods only apply to the level of cover that is greater the previously held.

For instance, if you previously had a top hospital cover with the previous insurer but with an excess, the waiting period only applies to the excess when joining Emergency Services Health.

A government leaflet containing further information is available by clicking here.

Pre-existing conditions

If a new member has a pre-existing condition before joining Emergency Services Health, they may need to serve a 12-month waiting period under the terms of our policy before benefits are payable for the particular condition. This does not apply for psychiatric care, rehabilitation or palliative care.

A pre-existing condition is one where signs or symptoms of your ailment, illness or condition existed at any time during the six months preceding the day on which you purchased your insurance or upgraded to a higher level of cover.

A medical practitioner appointed by Emergency Services Health (not your own doctor) is the only person authorised to decide that a condition is pre-existing. The practitioner must, however, consider any information regarding signs and symptoms provided by your own treating doctor or specialist.

A government leaflet containing further information is available by clicking here

Pre-existing conditions
State
FAQ Answer

If a new member has a pre-existing condition before joining Emergency Services Health, they may need to serve a 12-month waiting period under the terms of our policy before benefits are payable for the particular condition. This does not apply for psychiatric care, rehabilitation or palliative care.

A pre-existing condition is one where signs or symptoms of your ailment, illness or condition existed at any time during the six months preceding the day on which you purchased your insurance or upgraded to a higher level of cover.

A medical practitioner appointed by Emergency Services Health (not your own doctor) is the only person authorised to decide that a condition is pre-existing. The practitioner must, however, consider any information regarding signs and symptoms provided by your own treating doctor or specialist.

A government leaflet containing further information is available by clicking here

Am I covered for ambulance?
State
FAQ Answer

Emergency Services Health - Unlimited Ambulance Cover Australia-wide

Did you know that to call an ambulance can cost around $900 depending on your state or territory?

In a medical emergency, the cost of calling an ambulance is not at the top of your mind, but the bill after can be quite a shock if you do not have an ambulance cover. Good news when you are insured with Emergency Services Health all policies include ambulance cover- Australia Wide no matter if you’re in your home state or visiting another part of Australia.  

Comprehensive 100% Ambulance cover for emergency transport, clinically required non-emergency transport and treatment not requiring transport.*

 What's not covered?

Benefits are not payable:

For elective ambulance transport or other non-eligible ambulance service, for example when you pre-book transport between locations such as going from a hospital to a nursing home.

When you’re covered by a third party arrangement**.  For example where you are covered by an ambulance subscription or if you have access to a State/Territory ambulance transportation scheme. 

If you are still serving waiting periods.

*May be subject to waiting periods and other conditions.

**Third Party Arrangements:  Please note Queensland and Tasmanian residents have third-party arrangement ambulance services provided by state government schemes. In some other states, Department of Veterans Affairs Gold Card, pension and healthcare card holders may be exempt from paying for ambulance services.  Under those arrangements, the relevant scheme is responsible for the cost and Emergency Services Health does not pay a benefit. If the benefit for any eligible ambulance treatment costs are not fully covered by an arrangement or scheme, Emergency Services Health will pay a benefit.

Access Gap Cover (when admitted to hospital)
State
FAQ Answer

Under Emergency Services Health Access Gap Cover you may never have to pay a doctor’s bill. Your doctor can forward all accounts to us and we pay them on your behalf.

The Australian Health Service Alliance has recently written to Australian medical practitioners advising them about the launch of Emergency Services Health and our participation in Access Gap Cover. If the medical practice is not yet aware of us, or has not received their notification, ask them to contact our office on 1300 703 703, we are here to help.

Top Tip

Before you’re admitted to hospital check with your doctor if they are one of 25,000 doctors Australia wide who has an arrangement with us under the Access Gap Cover scheme.

When doctors bill under this arrangement we can pay higher benefits to eliminate or at least reduce your out of pocket costs.

While all doctors can be involved in Access Gap Cover, it is up to individual doctors to participate on a case by case basis.

Please speak with your doctor or specialist to see if they will participate in Access Gap Cover for any planned private hospital treatment. For a list of providers eligible to participate and who have agreed for their details to be published, please call us or use our online provider search.

$77.25*

Join now
* Quote Date: 6/04/2020
The price shown excludes any LHC loading and includes Base Tier Australian Government Rebate on Private Health Insurance. Lifetime Health Cover (LHC) is a Government initiative designed to encourage people to take out hospital insurance. If you don't hold private hospital insurance from 1 July after your 31st birthday you may pay an extra 2% on premiums for each year you go without private hospital insurance. Calculations of premiums are simulations, subject to variation depending on your personal circumstances and indicative only and are subject to confirmation and the Fund Rules. No information appearing on these online services is to be taken as a quote, an offer or as having qualified for cover. Please read our Products & Benefits Guide together with our State Premiums & Benefits brochure for details.
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HOSPITAL
All

Sleep Studies

Pain management with device

Weight loss surgery

Assisted reproductive services

Pregnancy and birth

Dialysis for chronic kidney failure

Joint replacements

Podiatric surgery (by a registered podiatric surgeon)

Plastic and reconstructive surgery (medically necessary)

Back, neck and spine

Lung and chest

Heart and vascular system

Diabetes management (excluding insulin pumps)

Breast surgery (medically necessary)

Skin

Pain management

Chemotherapy, radiotherapy and immunotherapy for cancer

Miscarriage and termination of pregnancy

Gynaecology

Gastrointestinal endoscopy

Digestive system

Male reproductive system

Kidney and bladder

Joint reconstructions

Bone, joint and muscle

Ear, nose and throat

Eye (not cataracts)

Brain and nervous system

Palliative care

Hospital psychiatric services

Rehabilitation